What are hives and angioedema. How do they differ in appearance and symptoms. What are the main causes of acute and chronic urticaria. How are hives and angioedema diagnosed and treated. What special situations can cause angioedema without hives.

Understanding Hives (Urticaria) and Angioedema

Hives, also known as urticaria, are itchy, raised, reddish areas on the skin that can appear suddenly and affect approximately 25% of the population at some point in their lives. Angioedema, on the other hand, is characterized by swelling below the surface of the skin and fatty tissue, often occurring in the face, throat, hands, and feet.

While hives and angioedema can occur independently, they are often related and may appear together. Understanding the differences between these two conditions is crucial for proper diagnosis and treatment.

Key Characteristics of Hives

• Itchy, raised, reddish welts on the skin
• Can appear anywhere on the body
• Range in size from a few millimeters to several centimeters
• Individual hives typically fade within 24 hours
• Skin returns to normal without leaving marks or bruising

Key Characteristics of Angioedema

• Swelling below the skin surface and in fatty tissue
• Often affects face, throat, hands, and feet
• Can also occur in the abdomen or other body areas
• Swollen areas may be painful
• Throat swelling can be life-threatening and requires immediate medical attention

Classification of Hives: Acute vs. Chronic Urticaria

Doctors classify hives based on their duration, which helps in determining potential causes and appropriate treatment strategies. The two main classifications are:

Acute Urticaria

Acute urticaria refers to hives that last for less than 6 weeks. These are often caused by:

• Viral infections (most common)
• Food allergies
• Drug reactions
• Environmental allergies
• Insect bites

Chronic Urticaria

Chronic urticaria is diagnosed when hives persist for more than 6 weeks. There are two types of chronic urticaria:

1. Chronic Spontaneous Urticaria: Hives appear without any apparent trigger
2. Chronic Inducible Urticaria: Hives are caused by specific environmental triggers

Chronic spontaneous urticaria is often associated with autoimmunity, while chronic inducible urticaria can be triggered by various factors such as heat, cold, or pressure on the skin.

Dermatographic Urticaria: A Common Form of Inducible Urticaria

Dermatographic urticaria is the most prevalent type of inducible urticaria. It can affect people of all ages and is characterized by the following:

• Triggered by shearing forces against the skin (e.g., scratching, pressure from tight clothing)
• Results in linear-appearing hives
• Symptoms appear within 5-7 minutes of skin contact
• Hives can last for 15 minutes to 3 hours
• Often responds well to antihistamine treatment
• May spontaneously resolve within 2-3 years

Is dermatographic urticaria dangerous? While it can be uncomfortable and bothersome, dermatographic urticaria is not considered dangerous. Like other forms of chronic urticaria, it does not typically pose serious health risks.

Angioedema Without Urticaria: Special Considerations

In some cases, angioedema may occur without the presence of hives. This situation requires special attention and additional evaluation by a healthcare professional. Angioedema without urticaria may be caused by:

1. Medication-Induced Angioedema

Certain medications can trigger angioedema without hives, including:

• Aspirin
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
• ACE inhibitors (blood pressure medications with generic names ending in “pril”, e.g., lisinopril)

Can ACE inhibitors cause angioedema after long-term use? Yes, ACE inhibitors can cause swelling at any time during treatment, even after years of use without previous issues.

2. Hereditary Angioedema (HAE)

Hereditary angioedema is a rare genetic disorder characterized by:

• A defect in the gene controlling C1 Inhibitor, a regulatory blood protein
• Improper functioning of C1 Inhibitor, leading to fluid shifts from blood to tissues
• Swelling that does not respond to antihistamines, corticosteroids, or epinephrine

Diagnosis and Treatment of Hives and Angioedema

Proper diagnosis and treatment of hives and angioedema are crucial for managing symptoms and preventing complications. Here’s an overview of the diagnostic and treatment approaches:

Diagnosis

How are hives and angioedema diagnosed? Diagnosis typically involves:

• A thorough medical history
• Physical examination
• In some cases, allergy tests or blood tests to rule out underlying conditions

Treatment Options

Treatment for hives and angioedema may include:

1. Antihistamines: Often the first-line treatment for both acute and chronic urticaria
2. Corticosteroids: May be prescribed for short-term use in severe cases
3. Omalizumab: A biologic medication used for chronic spontaneous urticaria that doesn’t respond to antihistamines
4. Epinephrine: Used in emergency situations for severe angioedema affecting the airways
5. Avoidance of triggers: Particularly important for inducible urticaria

Are there any natural remedies for hives and angioedema? While medical treatments are often necessary, some people find relief with natural approaches such as:

• Cool compresses to soothe itchy skin
• Oatmeal baths to reduce inflammation
• Wearing loose, breathable clothing to minimize skin irritation
• Stress reduction techniques, as stress can exacerbate symptoms in some individuals

Living with Chronic Urticaria: Coping Strategies and Quality of Life

Chronic urticaria can significantly impact a person’s quality of life. Here are some strategies to help cope with the condition:

• Educate yourself about the condition to better understand your symptoms and triggers
• Maintain open communication with your healthcare provider about your symptoms and treatment effectiveness
• Join support groups or online communities to connect with others experiencing similar challenges
• Practice stress management techniques, as stress can exacerbate symptoms in some cases
• Keep a symptom diary to identify potential triggers and track treatment effectiveness
• Consider seeking psychological support if the condition is causing significant emotional distress

How can patients with chronic urticaria improve their quality of life? In addition to medical treatment, patients can focus on:

• Developing a consistent skincare routine to minimize irritation
• Exploring relaxation techniques such as meditation or yoga
• Maintaining a healthy lifestyle with regular exercise and a balanced diet
• Working with their healthcare provider to find the most effective treatment plan

Recent Advances in Hives and Angioedema Research

The field of hives and angioedema research is constantly evolving, with new discoveries and treatment options emerging. Some recent advances include:

1. Improved Understanding of Underlying Mechanisms

Researchers are gaining deeper insights into the immune system’s role in chronic urticaria, which may lead to more targeted treatments in the future.

2. Novel Biologic Therapies

In addition to omalizumab, other biologic medications are being studied for their potential in treating chronic urticaria and angioedema.

3. Personalized Medicine Approaches

Scientists are exploring ways to tailor treatments based on individual patient characteristics and biomarkers, potentially improving treatment outcomes.

4. Advancements in Hereditary Angioedema Management

New medications and prophylactic treatments are being developed to better manage hereditary angioedema and reduce the frequency and severity of attacks.

What are the most promising areas of research for hives and angioedema? Some of the most exciting areas include:

• Identifying specific biomarkers to predict treatment response
• Developing new targeted therapies that address the root causes of chronic urticaria
• Exploring the potential of microbiome-based treatments
• Investigating the role of environmental factors in triggering or exacerbating symptoms

Prevention and Long-Term Management of Hives and Angioedema

While it’s not always possible to prevent hives and angioedema, especially in cases of chronic spontaneous urticaria, there are steps that can be taken to reduce the risk of outbreaks and manage the condition long-term:

Identifying and Avoiding Triggers

For those with inducible urticaria or known triggers, avoiding these factors can help prevent outbreaks. Common triggers may include:

• Certain foods or food additives
• Extreme temperatures (hot or cold)
• Pressure on the skin
• Sun exposure
• Specific medications

Maintaining a Healthy Lifestyle

While not a direct treatment for hives or angioedema, maintaining overall health can support the immune system and potentially reduce the frequency or severity of symptoms. This includes:

• Eating a balanced diet rich in fruits, vegetables, and whole grains
• Getting regular exercise
• Managing stress through relaxation techniques or counseling
• Getting adequate sleep

Regular Medical Follow-ups

Ongoing communication with healthcare providers is crucial for long-term management. This allows for:

• Monitoring of symptoms and treatment effectiveness
• Adjusting medications as needed
• Addressing any new concerns or complications
• Staying informed about new treatment options

How often should patients with chronic urticaria see their healthcare provider? The frequency of follow-up visits can vary depending on the severity of symptoms and treatment plan, but generally, patients should have check-ups at least every 3-6 months or more frequently if symptoms are not well-controlled.

Educating Others

For individuals with severe or chronic hives and angioedema, educating family members, friends, and colleagues about the condition can be beneficial. This can help:

• Increase understanding and support from others
• Ensure proper response in case of severe reactions
• Reduce stigma and misconceptions about the condition

Emergency Preparedness

For those at risk of severe angioedema, especially affecting the airways, being prepared for emergencies is crucial. This may involve:

• Carrying emergency medication (e.g., epinephrine auto-injector) at all times
• Wearing a medical alert bracelet or necklace
• Having an emergency action plan in place and sharing it with family and close friends

By implementing these strategies and working closely with healthcare providers, individuals with hives and angioedema can effectively manage their condition and maintain a good quality of life. As research continues to advance, new and improved treatment options may offer even better outcomes for those affected by these conditions.

Hives (Urticaria) & Angioedema Symptoms, Diagnosis & Treatment

Hives or welts, also known as urticaria, are itchy, raised, reddish areas on the skin. About a quarter of the general population can have hives during their life. Hives often appear without warning and may start at any age.

Angioedema is swelling below the surface of the skin and fatty tissue. Areas of swelling may be painful. Angioedema usually occurs in the face, throat, hands, and feet. Swelling can also occur in the abdomen or other areas of the body. Throat swelling can be life threatening and requires immediate medical attention. It is important to understand that angioedema is a medical term to describe swelling. It can be found with many different disorders. Angioedema can occur with or without hives. There are several different ways swelling can occur. Understanding the underlying mechanism of swelling or the specific disease is critical in determining the best treatment. 

Hives and Angioedema Symptoms & Diagnosis  

Hives are itchy and can occur anywhere on the body including the face, extremities, chest, back or face. Hives range in size from just a few millimeters to several centimeters. An individual hive usually fades within a 24-hour period and the skin returns to normal without leaving any marks or bruising.

Doctors will classify your hives based on how long you have had them. This helps doctors think about possible causes of your hives.  When hives occur for less than 6 weeks, we call this acute urticaria. When hives last longer than 6 weeks, we change the name to chronic urticaria. Sometimes the hives in chronic urticaria can occur with angioedema (swelling).  

There are two types of chronic urticaria: spontaneous urticaria, and chronic inducible urticaria. Chronic inducible urticaria is caused by an environmental trigger such as heat, cold, or pressure applied to the skin. The most common form of the inducible urticarias is called dermatographic urticaria.  It can occur in all age groups. Dermatographic urticaria is triggered by shearing forces against the skin such as scratching, pressure from tight clothing resulting in the linear appearing hives.   Stroking, or scratching the skin with a firm object will elicit the response in 5-7 minutes. Hives can last for 15 minutes to 3 hours.  Antihistamines are frequently an effective form of treatment. Spontaneous remission can occur in 2-3 years.

Both forms of chronic urticaria are not dangerous. Usually the cause of chronic spontaneous urticaria cannot be identified, but allergy is not typically a cause. This is a constant finding of medical authorities and researchers around the world. The absence of an identifiable trigger can be frustrating for patients.

Classifications

Modified from http://www. urtikaria.net/en/forms-of-urticaria/overview.html

Angioedema without Urticaria: A Special Situation

Talk to your doctor if swelling occurs without hives. This may suggest a special situation requiring additional evaluation. Sometimes high dose antihistamines may not improve your swelling. This is because the mechanism (cause) of swelling may be different than that of hives.

Swelling without hives may be due to:

1. Aspirin or nonsteroidal anti-inflammatory drug (NSAIDs) such as ibuprofen

2. ACE inhibitors (a class of blood pressure medications)

The generic names of these medications end in “pril” such as lisinopril. ACE inhibitors can cause swelling at any time during the course of therapy, even after years of being on the medication.  

3. Hereditary angioedema (swelling)

Hereditary angioedema (HAE) is a rare genetic disorder in which patients have a defect in the gene that controls a regulatory blood protein called C1 Inhibitor. When C1 Inhibitor does not function properly, fluids can shift out of the blood and into tissues to cause swelling. Antihistamines, corticosteroids and epinephrine will not be effective in treating swelling in patients with HAE, however targeted treatments are available once your diagnosis is established. Over 50% of patients with HAE will have their first swelling episode prior to age 12.

4. Acquired angioedema

Acquired angioedema (swelling) is an acquired form of C1 inhibitor deficiency that can occur in certain diseases. This is not hereditary or passed to your children.

Angioedema without Urticaria

Hives and Angioedema Treatment & Management  

The goals of treatment are to:

•    Provide relief of itching

•    Make hives more tolerable

•    Provide complete resolution of your hives

Medications will help your itching and reduce hives. Medications will not “cure” hives but can help to completely resolve them. Antihistamines are the best initial medication to treat your hives. Sometimes, a combination of several antihistamines or an increased dose of one antihistamine may be recommended.

Older antihistamines such as Benadryl (sedating antihistamines) may cause you to get sleepy, cause dryness and only last for several hours. Newer non-sedating antihistamines are less likely to make you sleepy. They have fewer side effects and last much longer. Non-sedating antihistamines (shown below) are often the first medication doctors will prescribe for your hives. High dosages, up to 4 times the recommended dose, are often well tolerated and can help control your itching. This will also help to prevent the use of other medications that may have more side effects.

About 50% of chronic spontaneous urticaria (hives over 6 weeks with no identifiable cause) will respond to antihistamine as discussed above. For those who do not improve on antihistamines, 65% respond to omalizumab (Ref 2). Omalizumab is an FDA approved treatment of chronic urticaria. This medication is injected under the skin once a month. Corticosteroids, such as prednisone or prednisolone may help hives. These are not an ideal treatment for long-term use but may have a role to relieve severe symptoms for a few days.  

Your doctor will outline a treatment plan that allows you to increase treatment during an outbreak of hives or swelling and reduce medications when the hives or angioedema are not as bothersome.

Chronic hives can last for many years but will often go away. Hives will resolve in half of patients within 1-2 years and 80-90% of patients will improve within 5 years. Even if a patient’s hives improve, it is not unusual to see the hives recur months to years later.

Antihistamines commonly used to treat urticaria:

References

1. Bernstein JA, Lang DM, Khan DA et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014;133:1270-7

2. Kaplan AP. Therapy of chronic urticaria: a simple, modern approach. Ann Allergy Asthma Immunol. 2014;112:419-25

3. Zuraw BL, Bernstein JA, Lang DM et al. A focused parameter update: hereditary angioedema, acquired C1 inhibitor deficiency, and angiotensin-converting enzyme inhibitor-associated angioedema. J Allergy Clin Immunol. 2013;131:1491-3

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Reviewed: 7/2023

Hives & Swelling | Riley Children’s Health

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Hives (urticaria) are an inflammation of the skin that causes red, raised welts or bumps. Hives itch, and they tend to come and go in groups. They range in size from a fraction of an inch to many inches in diameter.

The itchiness, grouping and size range of hives make them different from other allergic skin reactions like atopic dermatitis. Hives may occur suddenly as a reaction to a specific trigger (acute hives), or they may occur repeatedly or for long periods of time (chronic hives).

Hives may appear with angioedema (swelling of the deeper tissue of the skin). Angioedema usually does not itch and commonly occurs around the eyes, lips, tongue, hands and feet. Children who have hives with angioedema are more likely to have recurring or chronic hives.

The symptoms of hives may last anywhere from a few minutes to a few months or longer. Signs and symptoms of hives often include:

• Itching
• Red, raised bumps or welts on the skin that turn white when pressed (blanching)
• Sudden appearance and disappearance of these bumps

Angioedema (swelling) can occur at the same time as hives or as a separate reaction. Symptoms of angioedema include:

• Swelling around the eyes or the lining of the eyes
• Swelling of the hands and/or feet
• Swelling of the mouth and/or throat
• Difficulty breathing
• Stomach cramps

Hives can appear in one area or all over the body. If your child suddenly develops severe hives or angioedema and is having trouble breathing, is vomiting or loses consciousness, he or she may be experiencing anaphylaxis, a severe allergic reaction. Anaphylaxis is an emergency. If you think your child is experiencing a severe allergic reaction, take him or her to the hospital for immediate treatment.

Many different factors can cause your child to develop hives or swelling. These causes may be physical reactions, allergic reactions or nonallergic reactions.

Physical causes include:

• Cold
• Heat
• Pressure
• Sunlight
• Vibration
• Water

Allergic reactions can cause hives or swelling in response to:

• Pollens
• Dander
• Mold spores
• Foods
• Drugs
• Insects

Nonallergic causes of hives include:

• Infections
• Idiopathic reasons (no cause is found)
• Autoimmune conditions
• Other conditions

Diagnosis of Hives & Swelling

As a first step to diagnosing the cause of hives and swelling, the allergy doctors at Riley at IU Health will ask about your child’s medical history and do a physical exam. The focus will be on exposures that may be contributing to the problem.

Allery specialists will often perform an evaluation if the problem is chronic (for example, a child is has hives daily for two to three months). It can be extremely difficult to identify and confirm causes of chronic hives, but the allergy specialists at Riley at IU Health are trained to review your child’s medical history to help determine a possible cause and direct any further testing.

In the case of acute hives, there may be an obvious food or substance such as peanuts or a medicine that acts as a trigger. Acute hives may not require further evaluation or allergy testing unless a food is part of the history or there is anaphylaxis.

If your child’s allergist suspects a food allergy based on your child’s history, the doctor may perform a food allergy test and may suggest a food challenge to confirm the diagnosis.

Treatments

Treatments

An allergy specialist can treat both hives and angioedema. As with all allergic disorders, avoidance (keeping your child away from allergens) is the only sure therapy. If your child’s doctor is able to determine the cause of the hives, he or she can help you create a plan to avoid your child’s triggers.

Antihistamines are the most common medicines used for treating hives and swelling. These medicines work by blocking the chemicals in the skin that cause hives and swelling. Non-drowsy antihistamines are available. Your child’s allergist may also suggest other treatments.

Key Points to Remember

Key Points to Remember

• Hives are an inflammation of the skin that causes red, raised welts or bumps.
• Hives may appear with angioedema (swelling of the deeper tissue of the skin).
• Hives can have physical, allergic and nonallergic causes.
• Hives may occur suddenly as a reaction to a specific trigger (acute hives), or they may occur repeatedly or for long periods of time (chronic hives).
• Avoiding triggers and taking antihistamine medicines are the most common treatments for hives and swelling.

Support Services & Resources

Support Services & Resources

Learn more about hives and swelling by visiting the trusted websites below.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children’s care.

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American Academy of Allergy, Asthma & Immunology

Learn more about hives and how the symptoms are different from other allergic skin reactions.

American College of Allergy, Asthma & Immunology

Learn more about the causes of hives and treatment options.

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urticaria and angioedema | Nurmukhametova E.

Urticaria and angioedema, which are a reaction of skin vessels, can develop together or separately. If the edema covers both the skin and subcutaneous tissues, this condition is defined as angioedema. With urticaria, only the surface layers of the skin are involved in the process. It has been established that urticaria affects approximately 15% of the population, with women more often. The disease can develop at any age, but the peak falls on the period from the second to the fourth decade of life. Approximately half of the patients have simultaneous development of urticaria and angioedema; 40% develop only urticaria and 10% develop isolated angioedema. In most cases, urticaria is acute. But if the manifestations of the disease persist for more than 6 weeks, they speak of a chronic form of the disease.

Etiology
The cause of the development of urticaria are various factors; often the etiology of the disease remains unclear. Urticaria can develop after the administration of serum, ingestion of certain foods, inhalation of volatile allergens, insect bites, contact with any substances; this pathology is often associated with connective tissue diseases, neoplasms, infectious and endocrine diseases. Urticaria can be caused by various physical factors (cold, heat, sunlight, pressure, etc.). Factors that stimulate adrenergic and cholinergic reactions also play a role in the occurrence of the disease. The literature describes a case of increased plasma concentrations of noradrenaline, adrenaline and dopamine under stress, which led to the development of urticaria. Hereditary angioedema is characterized by recurrent, self-limiting exacerbations. The disease is inherited in an autosomal dominant manner with incomplete penetrance. In addition to the manifestation in childhood and a burdened family history, a test for the presence and activity of an inhibitor of Cl-esterase, which is one of the components of the complement system, can be used to diagnose this pathology. In cases where the cause of the disease cannot be established (70 – 80%), they speak of idiopathic urticaria.
Pathogenesis
To explain the pathogenesis of urticaria and angioedema, five mechanisms have been proposed: increased IgE synthesis, complement activation, the action of factors that cause the release of biologically active substances from mast cells, impaired arachidonic acid metabolism, and an idiopathic mechanism. A skin biopsy in the affected area shows swelling of the upper layers of the dermis, vasodilation, lymphocytic infiltrates around small vessels, which are formed due to an increase in the permeability of the latter. In chronic urticaria, infiltrates are predominantly represented by T-lymphocytes. The content of mast cells in the skin is increased. It has been established that histamine, synthesized and deposited by skin mast cells, plays a key role in the development of characteristic manifestations of the disease. When mast cells are activated, histamine and a number of other vasoactive substances are released, including kinins, leukotrienes, and prostaglandins. Kinins are vasoactive peptides and may play an important role in the development of urticaria. They reduce the contractility of smooth muscles, cause vasodilation and increase the permeability of the vascular wall. Antibodies of the IgE class, as well as complement-linked antibodies, interact with receptors on the surface of mast cells, causing the release of histamine. The release of histamine can be caused by certain substances (radiocontrast, chemicals) and medications (for example, opiates).
Diagnosis and clinical manifestations
When diagnosing, it is necessary to conduct a thorough history taking with a detailed description of the manifestations of the disease, taking into account provoking factors, the duration of the presence of blisters, associated symptoms, and the patient’s tendency to atopy. It is important to establish or reject a connection with any food, volatile or injectable substances, the presence of contact reactions, systemic diseases, hormonal influences, the influence of emotional factors, infections. Even if the driving mechanism is unknown, the listed factors are often triggers. Thus, about half of patients with idiopathic urticaria worsen when taking aspirin or non-steroidal anti-inflammatory drugs. Urticaria is associated with thyroid disease, lymphoma, and systemic lupus erythematosus.
Skin lesions in urticaria have the appearance of limited, hyperemic, itchy blisters ranging in size from 1 – 2 mm to several centimeters. The lesion may be localized or generalized. The existence of individual bubbles is limited to 24-48 hours, but they are replaced by new elements. Some patients develop angioedema, which is characterized by the involvement of deeper layers of the skin and subcutaneous structures, which, however, is not accompanied by itching. Some patients may experience respiratory, gastrointestinal, and cardiovascular symptoms. The value of laboratory tests and skin tests in diagnosing and establishing the cause of the disease is limited.
Treatment
Therapy for urticaria should be based on the identification and elimination of the cause of the disease. Unfortunately, as already mentioned, in most cases this is impossible, since either the cause cannot be established, or the disease is provoked by many factors. Therefore, the goal of treatment is usually to inactivate effector cells and block the release of inflammatory mediators. Specific receptors localized in cells and microvessels of the skin can also serve as a target for therapy.
Antihistamines (H ₁ receptor antagonists) are effective in about 65 to 70% of patients with urticaria or angioedema. The drugs of this group prevent the effects of histamine to a greater extent than contribute to the relief of already developed manifestations. In patients not responding to antihistamines, involvement of other inflammatory mediators in the pathological process should be suspected. Currently used H ₁ receptor antagonists (for example, loratadine) have approximately the same efficacy, but differ in the strength of sedative, cholinergic effects and tolerability. The choice of a particular drug may be determined by its side effect profile (eg, sedation may or may not be desirable) or pharmacokinetic characteristics. If any drug is ineffective or the patient does not tolerate it well, a drug of another chemical group may be prescribed. Possible combination of blockers H ₁ receptors (for example, during the day – a drug that does not have a sedative effect, and at night – a sedative drug). If treatment with H ₁ receptor antagonists is effective, the dose of the drug should be reduced gradually to avoid exacerbation of the disease.
H ₁ receptor antagonists can be combined with H ₂ receptor antagonists. The results of some studies indicate the feasibility of such a combination. As monotherapy, H 9 blockers0022 2 receptors are not effective enough. The appointment of these drugs is advisable only for certain types of urticaria and angioedema. In refractory cases, it is necessary to select a combination of drugs. Doses of cimetidine in various studies range from 400 to 1600 mg/day. Ranitidine is used in standard doses.
In addition to the above drugs, it is possible to use tricyclic antidepressants (for example, doxepin), b-agonists (terbutaline, etc.) and calcium channel blockers (nifedipine, etc.). These drugs, according to some reports, were effective in patients with chronic idiopathic urticaria. However, the available data are very few, so the use of these agents should be limited to refractory cases of the disease until more convincing results are obtained.

References:

Amerson AB “Allergic and drug-induced skin disease”. In: Herfindal T, Gourley DR Textbook of therapeutics. drug and disease management. Sixth edition, 1996. P. 882-4. Types, causes, symptoms, signs, diagnosis, first aid, treatment 0002 Treatment

Prevention

Urticaria is a common allergic disease characterized by the formation of a rash in the form of blisters or urticaria. Rashes with urticaria are localized mainly on the skin of the neck, face, body and hands. But there are cases when blisters appeared on the mucous membranes.

The disease affects 25% of the world’s population. Urticaria can appear in both children and adults. Signs are noted more often by women than men. The onset of the disease falls on middle age, namely about 35–40 years. 5% of patients are pediatric patients.

Classification

Depending on the duration of the course of the disease, modern medicine distinguishes the following types of urticaria:

1. Acute urticaria is a condition that is characterized by the manifestation of symptoms for at least 6 weeks. Patients also report headache and fever.
2. Acute recurrent – a type of disease with an exacerbation duration of up to 6 weeks. The difference is the duration of remission for 6 weeks.
3. Chronic urticaria is a disease that lasts longer than 6 weeks. This type can be viral, allergic or autoimmune in nature.

The following degrees are distinguished according to the rate of development of the disease:

1. Mild degree, which is characterized by the appearance of rashes in the amount of less than 20 pieces during the day. In this case, patients note a slight itching, which does not bring much discomfort.
2. The average degree of urticaria, characterized by noticeable itching of the skin and increased formation of urticaria (approximately 30-50 pieces per day).
3. Intensive degree. Itchy sensations disrupt daily life, and the number of rashes exceeds 50 pieces.

Depending on the mechanism of development of pathology, such types of diseases are distinguished as:

• allergic urticaria, which is provoked by immune processes. For example, the secretion of pathogen-specific immunoglobulins or the production of cytokine proteins that enhance the inflammatory response;
• non-allergic, in the development of which immune mechanisms are not involved;
• food, the provoking factor of which are certain foods;
• viral;
• solar, the cause of which is direct contact with the sun’s rays. This type of disease is mainly affected by women with liver pathologies and impaired pigment metabolism;
• contact, which occurs when the skin comes into contact with chemical materials, such as latex or silicone;
• aquagenic – an autoimmune form of the disease associated with interaction with water;
• cold. Occurs when the skin is exposed to low temperature;
• viral, caused by a viral infection;
• idiopathic urticaria is a disease whose cause remains unclear.

Causes and risk factors

The manifestation of an allergic disease can have a different etiology. For example, a clear provocateur of the disease is an insect bite or the use of certain drugs, including antibiotics. Blood transfusion, vaccination, and direct interaction with the allergen through food can also provoke the condition.

Other causes of hives include:

• contact with chemicals such as powders, lotions, home cleaning solutions;
• increased sensitivity of the skin to mechanical stress;
• allergies to cold, sun and heat;
• the use of cosmetics, including shampoos, eyelash and eyebrow dyes, as well as components of formulations used in nail extensions;
• exposure to pollen from flowers and plants, which can provoke an allergic reaction, including rhinitis or hay fever.

Despite the fact that many factors provoking the disease are known, the cause of about 30% of cases of the disease cannot be established.

In addition, many chronic non-allergic diseases can cause urticaria. These include lymphoma, thyroid pathologies, diabetes mellitus, and diseases of the gastrointestinal tract.

Symptoms

The main symptom of urticaria is the appearance on the mucous membranes and skin of rashes in the form of blisters. Urticaria are purplish, pinkish or pale pink in color. As a rule, formations rise above the surface of the skin. The condition is often accompanied by unbearable itching. In exceptional cases, soreness appears in the places of localization of the rash.

Some patients also report symptoms of urticaria such as:

• fever;
• general weakness;
• body aches;
• lowering blood pressure;
• tearing and redness of the eyes;
• severe swelling of the eyelids;
• loss of appetite.

In the case of an allergic type of urticaria, patients develop nasal discharge and nasal congestion, the sense of smell decreases and breathing through the nose is disturbed. These changes often lead to a change in hearing.

The severity of cold symptoms varies from patient to patient and may include skin redness, swelling and itching.

To understand what urticaria looks like in children, just look at the skin. In pediatric patients, the symptoms are similar to those in adults: itching, blisters up to 3 mm in size, redness. But, in addition to general signs, digestive disorders appear in the form of vomiting, diarrhea and abdominal pain.

When sick, blisters disappear without a trace 1–2 days after they appear. This is a feature of the disease that distinguishes it from other allergic pathologies.

Complications

Like any allergic disease, hives can lead to complications. Rashes in children often turn into ulcers. This is due to the constant scratching of blisters and infection.

Quincke’s edema is the most serious complication of the pathology. At the same time, patients have swelling of the larynx and face, which as a result can lead to respiratory failure. This is a critical situation that requires immediate medical attention.

Anaphylactic shock, which is often accompanied by a decrease in pressure, clouding in the eyes and heart rhythm disturbance, is another possible complication of the pathology.

Diagnosis

Diagnosis and treatment of urticaria is carried out by a group of doctors, depending on the cause of the disease. A physical examination for visible symptoms is done by a therapist. At the initial examination of the patient, the doctor measures blood pressure, body temperature, heart rate and feels the abdomen and lymph nodes. In the case of an allergic type of disease, an allergist-immunologist and a dermatologist are involved in the treatment.

Depending on the severity of the signs and characteristics of the course of the disease in the patient, the doctor may prescribe one or more diagnostic tests:

1. Complete blood count.
2. Immunoglobulin lgE general.
3. Allergotest.
4. Fecal analysis.
5. Gastroscopy.
6. Ultrasound of the abdominal organs.
7. Ultrasound of the pancreas.
8. Ultrasound of the thyroid gland.
9. Chest x-ray.
10. X-ray of the stomach.

In most cases, the disease stops within the first 14 days, so a special study is not required. After the provoking factor is established, laboratory diagnostics is prescribed.

Treatment

If signs of urticaria appear, it is important for the patient to provide first aid before contacting a doctor. To do this, calm the victim, unbutton the top button of the clothing and give a glass of mineral water to drink.

Symptoms of the disease can appear at any time when interacting with the allergen. Therefore, it is good to have anti-allergic drugs in the form of tablets and drops in the first-aid kit, which must be given to the patient. A cold compress should be applied to the swelling site.

Treatment of urticaria consists of several stages:

1. Exclusion of the allergen – the causative agent of the disease. To do this, you must stop taking medications that could cause pathology. You should also avoid hypothermia and overheating of the body.
2. Detection of foci of infection and their elimination.
3. Compliance with the diet for urticaria. It is important to exclude from the diet foods that can cause allergies: nuts, coffee, chocolate, honey, citrus fruits. The food plate should be filled with hypoallergenic foods, such as vegetable soups, low-fat broth, cereals from cereals, low-fat cottage cheese and yogurt, apples.
4. Use of medications, including antihistamines, immunosuppressants, and antidepressants. It should be remembered that medicines for the treatment of urticaria should be taken only as directed by a doctor.

With the onset of asphyxia against the background of Quincke’s edema, the patient is urgently prescribed a tracheostomy.

Topical ointments and creams for urticaria have not been shown to be effective. Therefore, the use of only these funds will not lead to a complete recovery.

Prophylaxis

In order to prevent urticaria, doctors advise to adhere to the following recommendations:

• in case of a tendency to develop allergies, contact with possible allergens should be avoided;
• it is important to treat diseases in a timely manner in order to avoid complications;
• a balanced diet is recommended;
• It is worth minimizing the physical and chemical effects on the skin.

The rate of recovery of a patient with urticaria is affected by age, cause of the disease, gender and individual characteristics of the organism. With timely access to a doctor, serious consequences can be avoided.

The author of the article:

Ivanova Natalya Vladimirovna

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